The British journal of general practice : the journal of the Royal College of General Practitioners
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Review Meta Analysis
Diagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis.
Selection of primary care patients for investigation of potential oesophagogastric cancer is difficult, as the symptoms may represent benign conditions, which are also more common. ⋯ Dysphagia, weight loss, and anaemia show the strongest association but with relatively low sensitivity and high specificity. The findings support the value of investigation of these symptoms, but also suggest that, in a population of patients who are low risk but not no-risk, investigation is not currently recommended.
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Reassurance is commonly recommended in guidelines for the management of low back pain in primary care, although it is poorly defined, and what it means to patients remains unknown. ⋯ The themes of implicit and explicit reassurance uncovered here correspond with ideas of affective and cognitive reassurance, respectively. Although the findings support the use of information and education to alleviate concerns, the role of implicit reassurance through relationship building and empathy remains less clear. The impact of these behaviours on outcomes should form a priority for future research.
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Demand for England's accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood. ⋯ Demographic characteristics were the strongest predictors of A&E attendance rates. Primary care variables that may be amenable to change only made a small contribution to higher A&E attendance rates.
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Observational Study
Nursing consultations and control of diabetes in general practice: a retrospective observational study.
Diabetes affects around 3.6 million people in the UK. Previous research found that general practices employing more nurses delivered better diabetes care, but did not include data on individual patient characteristics or consultations received. ⋯ Practices that primarily use GPs to deliver diabetes care could release significant resources with no adverse effect by switching their services towards nurse-led care.